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Let me tell you a little story of a patient who is very similar to the one you described. We had a patient at the county jail who was always complaining of chest pain. Appeared perfectly normal when we got there, and always turned out to be nothing. Three weeks ago, another unit got the call. They arrived on scene and found everything to be like always. Pt was CAAOX4, BS = and clear, SPo2 97%, HR and BP a little elevated, skin warm and dry. They determined that the patient was not having a cardiac event and transported in non-emergency...until he coded. Seems he was having an MI after all. Now we have a medic who has been suspended without pay while it is investigated, and who will probably lose his license over this. Could have been prevented if he had just followed protocol.

Hope this shows you why your way may not be the optimal way. This guy is a good medic. He just fell into the trap of thinking every cardiac patient will present in a certain way. I had a call a few months ago for a 25 year old having chest pains. No one expects a 25 year old to be having a cardiac event. This patient was a little diaphoretic, but he was doing landscaping on a warm day with high humidity so that was easily explained. He had no pertinent Hx. His vitals were normal initially, but changed enroute. We followed our CP protocol thinking initially that it was for nothing. The monitor showed no changes. Turns out he was having a RVI. Treat the patient, don't try to prove he is lying about what is going on

GazHaz, please spare me your stories and analogies. I'm not trying to be an ass but I've been a paramedic for the past 15 years, I've worked in both high volume urban settings and low and slow rural systems. I have my BS in nursing and have acted as training officer for two different departments. In short, I didn't just fall off the apple cart. I also have stories of patients who the medics thought were full of crap that ended up coding. I too have had personal experience where my initial perception with a frequent flyer ended up being wrong. So you didn’t “show me” anything other then you have no problem being condescending to someone you don’t really know.

You have also completely misrepresented what I've posted in this thread. I am NOT trying "to prove (anyone) is lying about what is going on". In fact I strongly resent the implication. I could care less if the patient is or is not lying. I never stated or even intimated that I am. What I am stating is that I will not run the chest pain protocol blindly. I will not hook every patient up ALS that I come into contact with - just in case. Once again, I am NOT a trained monkey. What the person tells me isn’t now nor ever will be the sole determining factor in how I care for a patient. If there’s one thing I’ve learned in my life and in this profession it’s that people lie all the time for almost no explainable reason. It’s not going to change how I care for them.

If I were to follow your advice, ALL calls I respond to should be ALS - you know, just in case they drop dead. In that kind of world there would be no thought process and every EMT and Paramedic would become the quintessential cookbook medic. And when that day comes will you then be defending medics that bottomed out a patient's BP with Nitro when there really wasn't any real indication that the patient needed it in the first place? Will you think its okay that we start giving out morphine, fentanyl, or other controlled pain meds to anyone that says the magic word?

In my opinion that is total backwards thinking. Maybe we should just go back to the old Johnny and Roy days and not even start an IV unless we can raise Rampart on the radio. Better yet, let's just do away with paramedics and pay Doctors to run the rigs, I'm sure they would just jump at the chance. I completely disagree with that brain dead approach to our profession which you seem to be espousing. Instead of telling medics to educate themselves and move our profession forward it seems you would rather dummy everything down.

Also you seem to be ignoring the fact that we're not giving out sugar pills here! We're administering heavy duty medications so we damn well shouldn't be giving them to people that don't really need them! Is that a smart thing to do? Isn't that negligent?

I do know one thing, if I did the follow your advice I wouldn’t be practicing in any of our local systems very long as the Medical Director would punch my ticket if I kept dumping meds into every – let’s say – questionably legitimate patient I came into contact with. Not only isn’t it “the optimal way” it’s also dangerous.

Man, I didn't want to come onto these boards and get into arguments but not only didn't I agree with your last post I honestly found it to be smug and patronizing. Sorry if this response upsets you but I have never been one to back down, especially when I didn’t throw the first punch.

English is important because someone who is well spoken is normally accepted as intelligent. (Shallow, yes. But that's the way our world works.) We need to stress english more in our schools because it is currently being gang-raped by spanish, ebonics, and that "fo-shizzle" bullshit. I blame both the media and parents.

Math is important because it is the universal language, and is unfortunately being left to computers.

History is important because we must not forget where we come from. If history is lost, than our children will be taught whatever ignorant, screwed up version the teacher wants to make up. (for example, Islam used to be a peaceful religion)

Science is the subject that binds it all together. It has a long past made up of laws and theories, requires reading and english skills, and relies heavily on math.

It's all kind of like the fire tetrahedron: you take one element out and it all falls apart.

Do you pull combi-tubes and intubate? Where I work we almost always respond with the FD. If they arrive on scene first for a code or respiratory arresst they have protocols to place combi-tubes. Most of them are emt-b's. So if your area is like mine or you have first responders or do medic assists with a volunteer service or something do you pull the combi-tubes and intubate? With all the changes in ACLS lately saying the bls airway is fine for the pt's in cardiac arresst I was just wondering everyones take on it. When we take in a code with a combi-tube in place the very first thing the docs do is pull the combi-tube and tube em. Sometimes they pull the combi-tube before we move them from the cot to the bed. It was just a question I had.

I quit EMS and now work full-time at a city animal shelter. Surprisingly, it's not that different from EMS, though now I get to be much less afraid of others' body substances. Oh yeah, and I got married.

Greetings from the west coast!! Northwest specifically!! I was a rescue swimmer in the Navy don't know what all those numbers are you guys are throwing around. I'll have a rum and coke heavy on the rum!! Plus a cigar if you have one!

Dead thread resurrection: Lethal triad of trauma=Hypothermia, Acidosis and Coagulopathy. Pet peeve of mine are trauma pt's. that are trauma naked and wheeled into shock trauma with no blankets or mylar foil. I won't even speak on fluids running wide with normotension or uncontrolled bleeding.....

Wow, you all are a bunch of f--king slackers. *I* am the one that gets the first post of 2014, and it's January 5th!?!!

My life update: Still back in Texas. Got back on a truck full time. Same company I was with a couple years back, but they were recently acquired by a growing provider in Texas. (No, not Acadian or AMR either.)

It's been pretty good. Still in paramedic school. One thing about an online program: you have to be able to study. The one Im doing isn't a fast-track or shortcut program by any means. And I don't have the longest attention span. So I'll look up an article on something, then find another, then another.. then a youtube video.. and next thing i know, instead of doing my homework, I've watched 15 podcasts, read half of emcrit.org, and 92 hours of youtube videos from some hospital ER in Dimblefark, Nowhere and I'm not even close to finishing my homework. The good thing is that I can take a lot of extra time to go over stuff that I might not understand fully. For example, I can draw the whole Renin-Angiotensin-Aldosterone System backwards, upside down, and in my sleep.

June 14th was dispatched for a man down, unknown if breathing at a trucking company. Arrived within three minutes and found male patient, in the back bed of a dump truck, in cardiac arrest with bystander CPR in progress. Partner took over compressions, I got him on the quick look pads with initial rhythm of V-fib. First shock delivered, compressions resumed and two or three minutes later patient had a perfusing pulse and rhythm was a-fib on the monitor. 12 lead EKG, bilat IV's, chilled NS, immobilized and BGL obtained while fire department was arriving and trying to figure out how to open the tailgate of the dump truck. Attempted ETT but patients jaw was clenched. We were able to manage with NPA without issues so I was happy with that.

Never lost pulses during transport but at one point bradyed down to a rate of 40 in a junctional rhythm. Dosed him with 0.5 of Atropien which brought rate up to sinus tach at 140 (whoops). Serial 12 leads showing an evolving septoanterior wall AMI with inferior wall involvment.

He was RSIed, intubated and vented at the ED, sent for head and chest scan and moved to CVICU and placed on artic sun protocol. Last I heard through friends of the family, he was still in the ICU somewhat alert and aware of his surroundings, is able to recognise family and is scheduled to be weaned off the vent yesterday (June 19) or today.

Still waiting on the medical director to get back to me with an official follow up and when I know I'll update.

Update:

The agency I was working for this day just had their annual banquet (which I attended) and they invited the patient and the co-worker that was doing compressions. I got to see the patient for the first time since that day and he is looking and feeling good. He is getting ready to go back to work and next year is going to run for a village position. Seeing him and hearing of his plans did a lot to turn my foul mood around. Outcomes like this do not happen on a daily basis for us but when they do it reminds us what we are really in this job for.

I'm back. Was chatting with a friend of mine about this place and some of the people I "met" on here. Thought I'd come back and check it out. Very sorry to see not much going on here (and feel bad that I didn't come back before now.

So...Let's see...First time on this board I was in my first year as a medic. That was 12 years ago. I'm a Critical Care Paramedic and FTO, at a private service that does 911 and all the other shit that private services do.

I'm married (he's also a medic, in school for RT) have a total of 4 kids between the two of us ranging in age from. 15-19. Just bought a new house so in process of getting one ready to live in and one ready to sell.

I'm known for my bluntness. My cursing. It's not that I'm trying to piss people off, it just happens. And I'm good with that.

Other than that...I'm a Cancer, INTP (hence the blunt), enjoy long walks on the beach, and much to my surprise, I scare new hires.

I came back because you people pushed me to be a better medic, and honestly I've been slacking. Hopefully enough of us can congregate again so y'all can challenge me again.

I enjoy most alcoholic beverages, partial currently to the Sazerac. However, used to be tradition for the newbie to buy a round...So whaddya all want, bar's open.

Interviewed for a field training officer position at my agency today. I think I did well on the "what if" questions, self evaluation questions and protocol test but I don't think I'll get selected. I totally bombed the "selling myself" portion of the interview. During that portion I was a bumbling idiot... Sigh....

Good luck on getting the position. Don't sell yourself short. Competency in the job tests, like the three you did well on, probably outshine customer service friendly tests like "selling yourself" (which kinda sounds like prostitution, but oh,well.)